MEDICARE: VILLA FRANCES AT THE KNOLLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015163	OTHER	NY	EMPIRE BLUE CROSS
2	A767936	OTHER	NY	OXFORD PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386633758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA FRANCES AT THE KNOLLS

Provider Business Mailing Address
First Line	:	22 VAN DUZER PL
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1014
Country	:	US
Telephone Number	:	845-987-5710
Fax Number	:	845-987-1368

Provider Business Practice Location Address
First Line	:	22 VAN DUZER PL
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1014
Country	:	US
Telephone Number	:	845-987-5710
Fax Number	:	845-987-1368

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LISA BROCKY
Credential	:
Telephone Number	:	845-987-5710

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	01/12/2013

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Directions to “VILLA FRANCES AT THE KNOLLS ” Practice Location

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